Franco-Gutiérrez Raúl, Pérez-Pérez Alberto J, Franco-Gutiérrez Virginia, Ocaranza-Sánchez Raymundo, Testa-Fernández Ana, López-Reboiro Manuel L, López-López Andrea, Santás-Álvarez Melisa, Crespo-Leiro María G, González-Juanatey Carlos
Department of Cardiology, Hospital Universitario Lucus Augusti (HULA), Lugo. Spain.
Department of Otolaryngology, Hospital Universitario Marques de Valdecilla, Santander. Spain.
Arch Cardiol Mex. 2019;89(1):1-7. doi: 10.24875/ACME.M19000001.
Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography.
A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event.
Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE.
CP is an independent predictor of MACCE in patients undergoing coronary angiography.
以颈动脉内膜中层厚度（CIMT）和颈动脉斑块（CP）衡量的颈动脉疾病，与既往无动脉粥样硬化疾病的人群发生主要不良心脑血管事件（MACCE）相关；然而，关于接受冠状动脉造影的患者的公开数据较少。本研究的目的是确定冠状动脉造影后颈动脉疾病是否与MACCE相关。
2002年至2013年间，共有390例连续患者在运动超声心动图和颈动脉超声检查后接受了冠状动脉造影。MACCE定义为中风、因动脉粥样硬化进展导致的心肌梗死或因中风或心脏事件导致的死亡。
2例患者失访（0.5%）。在平均6.0年（标准差2.9）的随访期间，52例患者（13.4%）发生了MACCE。1年、5年和10年的无事件生存率分别为96.4%（1.0）、88.7%（1.7）和81.4%（2.8）。CP组和CIMT>0.9mm组10年时的事件发生率较高（分别为23.2%对10.2%，p = 0.013；25.9%对13.3%，p = 0.023）。多因素分析显示，吸烟习惯（风险比[HR]2.51，95%置信区间[CI]1.36 - 4.62，p = 0.003）、肾小球滤过率（HR 0.98，95% CI 0.98 - 0.99）、主动脉瓣狭窄（HR 2.99，95% CI 1.24 - 7.21，p = 0.014）、不完全/未进行冠状动脉血运重建（HR 1.97，95% CI 1.06 - 3.67，p = 0.033）、胰岛素治疗（HR 2.63，95% CI 1.30 - 5.31，p = 0.006）以及CP（HR 2.36，95% CI 1.02 - 5.44，p = 0.044）是MACCE的预测因素。
CP是接受冠状动脉造影患者发生MACCE的独立预测因素。
